Researcher helps community group target HIV/AIDS

By Blythe McKay

(GUELPH, January 29, 2001) - The rising HIV/AIDS epidemic in a northern Cambodian town has prompted a U of G psychology professor to help community members gain access to information and economic resources needed to fight the disease.

Prof. Ian Lubek conducted an action research study -- that is, negotiating research goals and methods between the researcher and the community -- to determine the extent to which survivors of the past genocide in Siem Reap, a town adjacent to the famed Angkor Wat temples, are increasingly at risk for HIV/AIDS. To do this, he first interviewed community members, all of whom were past genocide survivors.

He also explored the availability of adequate medical resources and non-governmental organization resources, and the knowledge-base and ability of citizens to organize local solutions to the epidemic.

His involvement in Siem Reap led to the formation of a community-based group in the town and he is now seeking means to help them establish a computer network and gain access to financial and medical resources.

"It's almost impossible for the people of Siem Reap to access necessary treatment for HIV/AIDS," says Lubek, "The computer network will enable the group to seek advice from international experts, while the financial resources will help obtain basic antibiotics or perhaps anti-viral medication for those affected."

While visiting Northern Cambodia as a tourist in 1999, Lubek learned of the high-risk lifestyles led by genocide survivors, and the looming HIV/AIDS crisis, from a male survivor of the Pol Pot Regime (Pol Pot led the Khmer Rouge faction responsible for killing an estimated one quarter of the population during the 1970s). Lubek returned to the town of Siem Reap a year later to discuss ways for community members to intervene in the rapidly spreading epidemic. He became involved because there were no local psychologists with whom he could collaborate to help alleviate the situation- - they had been killed, or had left Cambodia under the Regime.

In February 2000, Lubek conducted a series of 19 in-depth interviews with citizens and doctors. These interviewees had survived the genocide and were aware of the local epidemic and high-risk behaviours. They also knew that because treatments were unaffordable, people diagnosed with HIV/AIDS or secondary opportunistic infections had no access to resources and were faced with rapid and inevitable death.

In his interviews, Lubek learned the virus was mainly being spread by young, female sex-trade workers. Tourists and locals seek sexual contact with these young teenage women in brothels, beer restaurants and other entertainment venues, often without protection. Lubek says that more than half of the sex-trade workers are HIV- positive. The local men who have contact with them in turn infect their wives, who give birth to seropositive children, continuing the spread of the epidemic within the community.

Lubek says some educational campaigns now exist in Cambodia, but these generally target high school students, not the genocide survivors, or the higher-risk beer-girls', the youngest women in the sex-trade industry who compete in restaurants to sell their sponsoring international beer brand. The community group believes that safer-sex education should reach high-risk members of the community.

"Group members agreed that a major priority was reaching 100 per cent condom compliance amongst the sex-trade workers," says Lubek, who plans to return to Siem Reap in February in part to help organize a workshop on this subject.

The initial pilot study of 19 interviews was sponsored by a grant from the University of Guelph's Research Advisory Board/Social Sciences and Humanities Research Council.

Toronto Star, Nov. 17, 2002., p. A2

One Canadian's dedication to AIDS education

MICHELE LANDSBERG

This is how the AIDS virus creeps quietly into a country town. This is how it lies in wait. This is how it leaps like a tiger into the bloodstream of the population.

At 4 o'clock every afternoon in steamy and booming Siem Reap, once an old French colonial town near Cambodia's mysterious ancient temple complex of Angkor Wat, the beer girls report for work. They're young and pretty, and they look fetching in the bright blazers and miniskirts of the beer companies they represent: Heineken, Budweiser, Labatt, Carlsberg, Foster's, Stella Artois, Beck's.

Men who enter Siem Reap's restaurants are immediately swarmed by a bevy of these brightly smiling young women, who must pop a beer can and keep the ring at least 24 times a night in order to fulfill their daily sales quota. If a beer girl can tempt a man to buy her a round as well, so much the better.

Naturally, things get out of control. Many survivors and descendants of those murdered by Pol Pot's Khmer Rouge in the genocide of the 1970s seem to exhibit a wild nihilism. Cambodian men have a tradition of boastful beer-drinking, 20 or 30 beers a night, in an atmosphere of macho competitiveness. Then they want unprotected sex, and consequences be damned.

Many tourists, too, come to buy sex where they think they'll find clean young girls.

The tourists started to flock back to Angkor Wat  a quarter of a million a year in Siem Reap  after the Khmer Rouge was routed and the land mines were finally cleared in 1997. Besides the 400 prostitutes in the local brothels, there are another 400 beer girls plying their anxious trade in the bustling restaurants.

The beer girls are what the United Nations calls "indirect"  that is, occasional  sex workers. Local prostitutes, who earn $1 a trick and do a volume business, have been successfully trained to insist on condom use. Not so the beer girls, who work in an atmosphere of flirtation and fake romance. About half of them give in and agree to paid sex; they can earn $25 to stay the night. Unlike the brothel workers, they find it hard to persuade the customers to use condoms. (Might spoil the sexy flirtatiousness of the whole charade). It's even harder to persuade their boyfriends.

Brothel workers in Siem Reap have an HIV infection rate of 43 per cent. And the beer girls, "aristocrats" of the trade, are rapidly catching up. Between 15 per cent and 23 per cent are now infected. And when local men patronize them, those men become the bridge on which the tiger travels.

The married women of Siem Reap are shy and unassertive. They don't ask their husbands to use condoms. The virus comes home from the restaurant to the bedroom, and now 11 per cent of the pregnant married women who come to the local ante-natal clinic are HIV positive.

Cambodia, reeling from years of mass slaughter under the Pol Pot regime, devastated by war, was first assaulted by the HIV epidemic when United Nations peacekeepers and multinational de-miners arrived in the early '90s. The government managed to bring the infection rate down  it's less than 3 per cent in the country as a whole. But in Siem Reap, with its tourism, the rates are higher and rising. (In Canada, by comparison, the infection rate is 0.16 per cent).

And here's a Canadian connection: Several years ago, a mild-mannered psychology professor from the University of Guelph stopped off to see Angkor Wat on his way to Australia. Ian Lubek was shocked to learn of the HIV prevalence rates. "You're a psychology professor; can't you think of something to do about it?" a local guide challenged him.

He took up the challenge. Lubek now spends every spare minute and dollar on a tiny organization that he helped establish in Siem Reap.

With local nurses and government health workers, he has set up a peer education program, training beer girls in AIDS prevention and outreach among their friends.

Most of the women are illiterate. They migrate from the rice paddies to help support their impoverished families. When Lubek and his colleagues showed them a video about AIDS prevention, they didn't recognize the dots on the screen as a picture; they had never seen TV. Working with a Singapore doctor, Lubek and his team have adapted her comic book for sex workers to show the Siem Reap women how to coax, argue, persuade, tease and flatter both customers and recalcitrant boyfriends into wearing condoms.

Beer girls have to supplement their income. They need a minimum of $100 a month to live; pushing beer brings them half that. Some of them work in construction on the new roads, but the pressure to sell sex is unremitting  and seemingly well rewarded.

Only recently, when one of the beer girls died alone of AIDS, did many of them feel the shock of personal peril. Her body was carted away by police and cremated without a funeral of any kind. The beer girls were stunned that the companies whose uniforms they wear did not care about them and would not look after them.

So far, Lubek has been unsuccessful in getting any of the major beer companies to launch an anti-AIDS program or supply antiretroviral drugs to their beer girls in Cambodia. The brewers insist that it is not they, but local distributors, who have hired the women.

Siem Reap is so poor that the public hospital has no antibiotics to treat opportunistic infections. Telephones are non-existent or non-functioning.

Lubek was able to get his program started with a small two-year grant from the Elton John AIDS Foundation and the enthusiastic help of his students, but he hopes the beer firms will meet their responsibilities and provide support, instruction, adequate pay and a good health plan for the indirect sex workers who are their indirect employees.

If they don't, the breweries will become another plank in the bridge over which the tiger will leap into ravaged Cambodia.

Alert: Friends of Women's College Hospital. All of you who helped to save this historic women's hospital, in a battle that began 13 years ago, are asked to come to the annual general meeting of the Friends on Thursday, Nov. 21 at 5:30 p.m. in the hospital's main floor auditorium.

The downtown site, so dear to so many of us, was supposed to become a leading, innovative Women's Ambulatory Care Centre after our hospital was forced to merge with Sunnybrook. How is that plan faring? To learn more, and help safeguard the hospital's future, circle Thursday on your calendar. I wouldn't miss this meeting. Hope to see you there.

Michele Landsberg's column usually appears in the Star Saturday and Sunday.
Her e-mail address is mlandsb@thestar.ca